Robotic Transthoracic Thoracic Duct Ligation

  • Kemp KernstineSr.
  • John K. Waters


Historically, thoracic duct ligation has been performed by thoracotomy. The video-assisted technique has offered possibilities, but because of the thoracic duct location deep in the mediastinum and the challenges related to patient’s anatomy, the robotic approach offers the consistent opportunity of performing a very precise procedure in often a confined space despite the anatomical variability. The most common location chosen for thoracic duct ligation is just as it enters the mediastinum from the retroperitoneum and just deep to the rightward and vertebral area behind the descending aorta. Medial retraction of the aorta provides the best exposure for a complete ligation. Many advocate a mass ligation; although some recommend dissection to identify the duct for accurate and precise ligation.


Chylothorax Pleural effusion Esophagectomy Chyloma Chylomicrons Octreotide Somatostatin Lymphangiogram Pleurodesis Povidone-iodine 

Selected References

  1. Artemiou O, Marta G-M, Klepetko W, Wolner E, Muller M-R. Pleurovenous shunting in the treatment of nonmalignant pleural effusion. Ann Thorac Surg. 2003;76:231–3.CrossRefGoogle Scholar
  2. Bender B, Murthy V, Chamberlain RS. The changing management of chylothorax in the modern era. Eur J Cardiothorac Surg. 2016;49:18–24.CrossRefGoogle Scholar
  3. Brinkmann S, Schroeder W, Junggeburth K, Gutschow CA, Bludau M, Hoelscher AH, Leers JM. Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus. J Thorac Cardiovasc Surg. 2016;151:1398–404.CrossRefGoogle Scholar
  4. Crucitti P, Mangiameli G, Petitti T, Condoluci A, Rocco R, Gallo IF, Longo F, Rocco G. Does prophylactic ligation of the thoracic duct reduce chylothorax rates in patients undergoing oesophagectomy? A systematic review and meta-analysis. Eur J Cardiothorac Surg. 2016;50(6):1019–24. Scholar
  5. Davis HK. A statistical study of the thoracic duct in man. Am J Anat. 1915;17:211–44.CrossRefGoogle Scholar
  6. Davis KK, Berry GJ, Raffin TA, Faul JL. Thoracic lymphatic disorders. Lymphat Res Biol. 2004;2:131–7.CrossRefGoogle Scholar
  7. Doerr CH, Allen MS, Nichols FC, Ryu JH. Etiology of chylothorax in 203 patients. Mayo Clin Proc. 2005;80:867–70.CrossRefGoogle Scholar
  8. Hematti H, Mehran RJ. Anatomy of the thoracic duct. Thorac Surg Clin. 2011;21:229–38.CrossRefGoogle Scholar
  9. Kalomenidis I. Octreotide and chylothorax. Curr Opin Pulm Med. 2006;12:264–7.CrossRefGoogle Scholar
  10. Langert J, Trachiotis G. Chylothorax. Curr Respir Med Rev. 2012;8:322–6.CrossRefGoogle Scholar
  11. Martucci N, Tracey M, Rocco G. Postoperative chylothorax. Thorac Surg Clin. 2015;25:523–8.CrossRefGoogle Scholar
  12. McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med. 2010;104:1–8.CrossRefGoogle Scholar
  13. Nadolski G, Itkin M. Thoracic duct embolization for the management of chylothoraces. Curr Opin Pulm Med. 2013;19:380–6.PubMedGoogle Scholar
  14. Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg. 2007;32:362–9.CrossRefGoogle Scholar
  15. Riquet M, Le Pimpec Barthes F, Souilamas R, Hidden G. Thoracic duct tributaries from intrathoracic organs. Ann Thorac Surg. 2002;73:892–8. Discussion 8–9.CrossRefGoogle Scholar
  16. Shah RD, Luketich JD, Schuchert MJ, Christie NA, Pennathur A, Landreneau RJ, Nason KS. Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg. 2012;93:897–903. Discussion –4.CrossRefGoogle Scholar
  17. Smoke A, Delegge MH. Chyle leaks: consensus on management? Nutr Clin Pract. 2008;23:529–32.CrossRefGoogle Scholar
  18. Squitieri RP, DiMeo AC. Left-sided robotic thoracic duct clipping for chylothorax. J Thorac Cardiovasc Surg. 2013;145:299–300.CrossRefGoogle Scholar
  19. Soto-Martinez M, Massie J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev. 2009;10:199–207.CrossRefGoogle Scholar
  20. Sriram K, Meguid RA, Meguid MM. Nutritional support in adults with chyle leaks. Nutrition. 2016;32:281–6.CrossRefGoogle Scholar
  21. Steven BR, Carey S. Nutritional management in patients with chyle leakage: a systematic review. Eur J Clin Nutr. 2015;69:776–80.CrossRefGoogle Scholar
  22. Thompson KJ, Kernstine KH, Grannis FW Jr, Mojica P, Falabella A. Treatment of chylothorax by robotic thoracic duct ligation. Ann Thorac Surg. 2008;85:334–6.CrossRefGoogle Scholar
  23. Tutor JD. Chylothorax in infants and children. Pediatrics. 2014;133:722–33.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Thoracic Surgery, Robert Tucker Hayes Foundation Distinguished Chair in Cardiothoracic Surgery, Department of Cardiovascular and Thoracic SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Cardiothoracic SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA

Personalised recommendations