Thoracoscopic lung biopsies in heaves-affected horses using a bipolar tissue sealing system.
Authors: Relave Fabien, David Florent, Leclère Mathilde, Alexander Kate, Hélie Pierre, Meulyzer Michael, Lavoie Jean Pierre, Marcoux Marcel
Journal: Veterinary surgery : VS
Summary
# Thoracoscopic Lung Biopsy in Heaves: Evaluating the LigaSure® Vessel Sealing System Obtaining diagnostic lung tissue from horses with equine asthma (heaves) has traditionally been challenging; this 2010 study assessed whether bipolar thermal sealing technology could safely facilitate thoracoscopic biopsy collection in affected animals. Twelve heaves-affected horses underwent thoracoscopic lung biopsy using the LigaSure™ Vessel Sealing System via a 13th intercostal space portal, with two additional instrument portals positioned between the 12th and 15th intercostal spaces, yielding 34 total biopsies and allowing monitoring of clinical variables, arterial blood gases, and postoperative complications. The procedure proved efficient—mean surgical time of 23 minutes with an acceptable 5.6% complication rate—and importantly, horses with clinical heaves signs demonstrated significantly lower arterial oxygen pressure (PaO₂) than asymptomatic heaves-affected horses, confirming the technique's capacity to differentiate pathophysiological states; however, postoperative pneumothorax developed radiographically in 59% of cases, and one horse fatally deteriorated with tension pneumotharax five days post-procedure despite monitoring. Whilst the LigaSure® system enables rapid, effective peripheral lung tissue harvest with manageable morbidity, the risk of incomplete pulmonary seal and subsequent life-threatening tension pneumotharax demands rigorous postoperative surveillance—potentially including serial thoracic radiographs and close observation for respiratory deterioration—particularly in horses showing clinical exacerbation at the time of biopsy.
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Practical Takeaways
- •LVSS thoracoscopic lung biopsy is feasible for diagnosing heaves but carries a serious risk of delayed tension pneumothorax—mandatory radiographic monitoring for several days post-procedure and client communication about this risk are essential
- •Five horses required intraoperative oxygen supplementation; clinicians should be prepared to manage hypoxia in acute exacerbation cases during the procedure
- •Incomplete lung sealing at biopsy margins appears to be the primary mechanism of postoperative pneumothorax; technique refinement and careful margin inspection are critical
Key Findings
- •Thoracoscopic lung biopsy using LigaSure Vessel Sealing System (LVSS) had a 5.6% complication rate with mean surgical time of 22.9±8.0 minutes
- •Postoperative pneumothorax was detected radiographically in 58.8% (20/34) of procedures, with one fatal tension pneumothorax occurring 5 days post-op
- •Mean PaO2 was significantly lower in heaves-affected horses showing clinical signs compared to those without clinical signs
- •Technique was effective for harvesting peripheral lung tissue but requires close postoperative radiographic monitoring to prevent life-threatening tension pneumothorax