Miller's knot lobectomy compared to the standard technique
A series of cases in which the Miller’s knot lobectomy was used was compared to use of the standard lobectomy technique.
In the Miller’s technique, there were two cats involving three lobes that were removed because of neoplasm and 10 dogs in which 14 lobes were removed. The reasons for emergency lobectomy was lung consolidation in four dogs (involving six lobes); trauma, with severe tears or openings in four dogs (involving six lobes); a leaking congenital bulla in one dog; and one with an abscess and foreign body (wooden stick).
Time taken to perform a lobectomy with this technique ranged from three to seven minutes. No leaks or complications with the pedicle were observed in any of the cases.
Only limited dissection was needed to perform the lobectomies. There were no leaks or fistula noted after a four-month follow-up.
A cohort group of 12 other animals was compared. These cases had a standard lung lobectomy with ligation of each pulmonary lobar artery and vein and oversewing of the lobar bronchus with simple interrupted sutures of 3-0 to 4-0 polypropylene.
There were no complications in this group of patients, either, but the time to complete the lobectomy was greatly increased (ranging from 15 to 35 minutes).
Based on the similar result, other than time of the procedure, either procedure was found to be safe and effective. But the conventional lobectomies, where artery, bronchus and vein are all managed individually, were found to be technically more difficult.
Significant time saving (ranging from 12 to greater than 30 minutes) was noted with each lobectomy. Therefore it is recommended, where possible, that this simple technique be considered and used when possible for lung lobectomy.
This is particularly recommended when managing animals less than 20 kg in size. In very large pedicles, such as in dogs weighing greater than 30 kg, the Miller’s knot technique also can be used safely but will require multiple flashings of the hemostatic forceps because the knot is being drawn tight.
This technique also has been very effective for the removal of liver lobes as well in the ligation of all wide vascular pedicles.
More in this package:
Methodology: figure 1
Methodology: figure 2
Methodology: figure 3
Methodology: figure 4
Applying a Miller's knot: step 1
Applying a Miller's knot: step 2
Applying a Miller's knot: step 3
Case study: step 1
Case study: step 2
Case study: step 3
Comparison to standard technique