Robotic Treatment of Postoperative Chylothorax

Our plain-English summary of Robotic Treatment of Postoperative Chylothorax, by A. Fiorelli, A.C. Izzo, V. Di Filippo, et al (Annals of Thoracic Surgery Short Reports, 2025).

The study

• Authors: A. Fiorelli, A.C. Izzo, V. Di Filippo, F. Capasso, D. Galetta, G. Natale
• Journal: Annals of Thoracic Surgery Short Reports
• Published: 2025;3(1):222-224
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A high-output chyle leak developed in a 69-year-old man who had undergone pleurectomy and decortication for malignant pleural mesothelioma. Conservative treatment was unsuccessful while a clear area of leakage could not be identified on lymphangiography. Right-sided robotic reexploration with ligation of the thoracic duct was successfully performed. The patient was discharged 6 days later, and no recurrence was observed.

© 2024 Published by Elsevier Inc. on behalf of The Society of Thoracic Surgeons.

In plain English

This case report described one patient, a 69-year-old man who had undergone pleurectomy and decortication (surgery removing the lining around the lung) for malignant pleural mesothelioma. The article did not discuss asbestos exposure. On the third day after surgery, his chest drainage became chylous (milky lymph fluid), with a triglyceride level of 190 mg/dL. Despite intravenous nutrition, stopping food by mouth and octreotide, drainage was 1.5 L per day. Lymphangiography on day 7 did not find the leak. On day 9, surgeons used a right-sided robotic approach to clip the leaking thoracic duct, cover it with a fibrin sealant patch, and perform talc pleurodesis. The authors attributed the duct rupture to the aggressive removal of mediastinal pleura. The day after this operation, drainage showed no chyle. The chest tube was removed 5 days later, and the patient went home the next day. A chest X-ray a week later showed no return of the effusion. The authors concluded robotic ligation was feasible but expensive, and should be used only in selected cases where other minimally invasive approaches are at high risk of failure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 69-year-old man who had undergone pleurectomy and decortication for malignant pleural mesothelioma
• Exposure: No asbestos or other exposure is reported. The article concerns treatment of a chyle leak (chylothorax) after surgery for malignant pleural mesothelioma.
• Main results:
  • On postoperative day 3, chest drainage became chylous, with a triglyceride level of 190 mg/dL
  • Despite conservative treatment (parenteral nutrition, stopping oral feeding, octreotide), daily output was 1.5 L/d
  • Lymphangiography on postoperative day 7 did not detect the leak, and no embolization was done
  • The authors attributed rupture of the thoracic duct to aggressive resection of mediastinal pleura during the mesothelioma surgery
  • At robotic reexploration, the fistula was clipped and covered with a fibrin sealant patch, then talc pleurodesis was performed and a 28F chest tube placed
  • On postoperative day 1 after the robotic operation, drainage became serosanguineous with no evidence of chyle
  • The chest tube was removed 5 days later and the patient was discharged the day after
  • Chest radiography 1 week later showed no recurrence of chylous effusion
• The authors' conclusion: The authors concluded that their case confirmed robotic ligation of the thoracic duct is a feasible strategy for refractory chylothorax. They added that it remains expensive and should be used only in selected cases when other minimally invasive approaches are at high risk of failure.
• Limitations the authors state:
  • The authors state the robotic procedure remains expensive and should be used only in selected cases when other minimally invasive approaches are at high risk of failure

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

Related studies

• Treatment of postoperative chylothorax through laparoscopic thoracic duct ligation — B.C. Vassallo, D. Cavadas, et al. (2002)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series — D.C. Mares, P.N. Mathur (1998)
• Laparoscopic thoracic duct clipping for persistent chylothorax after extrapleural pneumonectomy — N. Tsubokawa, Y. Hamai, et al. (2012)
• An unusual case of chylothorax — L.A. Benninger, J.A. Ross, et al. (2018)
• A Cause of Bilateral Chylothorax: A Case of Mesothelioma without Pleural Involvement during Initial Diagnosis — E. Kurtipek, M.İ. Eren Karanis, et al. (2015)

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