Pesq. Vet. Bras.

38(11):2117-2123, novembro 2018

DOI: 10.1590/1678-5150-PVB-5648

Original Article
Pequenos Animais/Small Animals Diseases
ISSN 0100-736X (Print)
ISSN 1678-5150 (Online)

PVB-5648 SA

Lung biopsy with guillotine cutting needle and biopsy

forceps though transdiaphragmatic thoracoscopy in
dogs with pulmonary alterations1
Letícia M. Fratini2*, Cristiano Gomes3, Luciana Queiroga4, Fabiane R. Santos2,
Alexandra P. Fantinatti5, Saulo P. Pavarini6, Daniel G. Gerardi3 and Carlos Afonso C. Beck3
ABSTRACT.- Fratini L.M., Gomes C., Queiroga L., Santos F.R., Fantinatti A.P., Pavarini S.P.,
Gerardi D.G. & Beck C.A.C. 2018. Lung biopsy with guillotine cutting needle and biopsy
forceps though transdiaphragmatic thoracoscopy in dogs with pulmonary alterations.
Pesquisa Veterinária Brasileira 38(11):2117-2123. Programa de Pós-Graduação em Ciências
Veterinárias, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves 9090, Agronomia,
Porto Alegre, RS 90540-000, Brazil. E-mail: lefratini@gmail.com
Lung diseases are common in small animal clinical routine. Diagnosis is usually affected
due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound
are acceptable screening tests, although lung biopsy can provides a precise diagnosis.
Thus thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases
and offers the benefits such as improved illumination and magnification of the image
when compared with thoracotomy. In this study we evaluated the transdiaphragmatic
thoracoscopic-assisted techniques of lung biopsy with a the guillotine cutting needle
and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors.
Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital
of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of Universidade Federal do
Rio Grande do Sul (UFRGS), were assessed. Inclusion criteria were presence of nodules on
chest radiography and triage tests without changes that could hinder general anesthesia and
surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic
ports were established: the first port for working instruments; the second paraxyphoid
port for the telescope. Three samples were collected using each sampling method from
each lesion or from tumors macroscopically similar whenever their size was less than one
centimeter. The samples were sent for histopathological examination in the Veterinary
Pathology Laboratory of FAVET/UFRGS. Surgical time was recorded from first incision to
wound closure and surgical complications were reported. The dogs were evaluated for the
presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence.
No conversion to open surgery was necessary during the thoracoscopic procedure in any
patient. Thoracoscopic assisted biopsy using guillotine needle and biopsy forceps was a safe
and fast technique, without perioperative complications. Both devices provided good quality
samples for histopathological analysis of lung abnormalities. However the cutting guillotine
needle was more efficient especially in larger pulmonary nodules. The transdiaphragmatic
access provided optimal approach for both hemithoraces.
INDEX TERMS: Lung biopsy, transdiaphragmatic thoracoscopy, dogs, video surgery, lung neoplasm,
chest diseases, thoracic surgery.

1
Received on March 12, 2018. 4
Veterinarian, Hospital de Clínicas Veterinário, Universidade Federal
Accepted for publication on March 27, 2018. do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves 9090, Porto Alegre,
2
Post-Graduated course in Veterinary Medicine (PhD), Universidade RS 90540-000.
Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves 9090, Porto 5
Autonomous Veterinarian, Hospital Veterinário Pet Support, Av. Plinio
Alegre, RS 90540-000, Brazil. *Corresponding author: lefratini@gmail.com Brasil Milano 1135, Higienópolis, Porto Alegre, RS 90520-002.
3
Departamento de Medicina Animal, Faculdade de Medicina Veterinária, 6
Departamento de Patologia Animal, Faculdade de Medicina Veterinária,
Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves
9090, Porto Alegre, RS 90540-000. 9090, Porto Alegre, RS 90540-000.

2117
2118 Letícia M. Fratini et al.

RESUMO.- [Biópsia pulmonar com agulha cortante histological examination (Withrow 2013). Samples for
guilhotinada e pinça de biopsia por toracoscopia this examination can be obtained by biopsy performed by
transdiafragmática em cães com alterações pulmonares.] thoracotomy, thoracoscopy or percutaneous with guillotine
As afecções pulmonares são comuns na rotina clínica de cutting needle (Wilson & Dungworth 2002, Baez & Sorenmo
pequenos animais, todavia, por apresentarem sintomas 2004, Basso et al. 2010).
inespecíficos, muitas vezes o diagnóstico dessas doenças Infirmities such as primary and metastatic neoplasm,
torna-se limitado. Recursos de imagem como a radiografia inflammatory and infectious processes, circulatory disorders
e a ultrassonografia torácica são válidos como exames de and degenerative conditions have their definitive diagnosis
triagem, mas somente a biopsia pulmonar pode possibilitar um through histological examination (Chojniak  et  al. 2011).
diagnóstico específico da doença. A toracoscopia fornece um In order to perform the biopsy, video-assisted thoracoscopy
meio minimamente invasivo de diagnóstico para as doenças is recommended because it causes less trauma to the patient
torácicas e oferece os benefícios de melhor iluminação e when compared to thoracotomy (Saviano & Tazzioli 1998)
ampliação da imagem, quando comparado com a toracotomia. Thoracoscopic, pleuroscopic or video-assisted thoracoscopic
O presente estudo teve como objetivo avaliar as técnicas de surgery (VATS), when compared to thoracotomy, is a safe
biópsia pulmonar por meio da agulha cortante guilhotinada technique with minimal thoracic wall trauma, causing less pain,
e da pinça de biopsia, guiadas por toracoscopia, pelo acesso reduction of pneumothorax and subcutaneous emphysema,
transdiafragmático em cães que apresentavam imagem providing rapid recovery of the patient (Solli & Spaggiari 2007).
sugestiva de nódulo pulmonar em exame radiográfico prévio. Pulmonary biopsy in dogs through thoracoscopy is still
Foram utilizados 14 cães, independente de raça, sexo, idade poorly studied and usually requires the use of two or three
e peso corporal. Somente caninos com nódulos visíveis na portals and the use of different types of instruments to obtain
radiografia torácica e que apresentaram condições clínicas the tissue sample (Potter & Hendrickson 1999).
e laboratoriais de serem anestesiados foram incluídos no The aim of this study is to describe and evaluate techniques
estudo. Os cães foram posicionados em decúbito dorsal for pulmonary biopsy using guillotine cutting needle and
e foram realizados dois acessos à cavidade torácica: um biopsy forceps, guided by thoracoscopy for transdiaphragmatic
primeiro portal intercostal, para introdução dos dispositivos and intercostal paraxiphoid accesses in dogs presenting a
de biopsia; e outro portal paraxifoide transdiafragmático suggestive image of pulmonary nodule on previous radiographic
para introdução do endoscópio. Com cada instrumento de
examination.
biopsia foram coletadas três amostras do mesmo nódulo
ou de nódulos macroscopicamente semelhantes e próximos
quando o tamanho destes era inferior a um centímetro. MATERIALS AND METHODS
Posteriormente as amostras foram encaminhadas para exame The present study was approved by the Animal Ethics Committees
histopatológico. O tempo cirúrgico foi cronometrado da (AECs) of the Rio Grande do Sul Federal University (Universidade
incisão ao fechamento da ferida, etodas as informações foram Federal do Rio Grande do Sul, UFRGS), through the approval document
registradas. No pós-operatório os cães foram avaliados quanto à and under the protocol number 26239. The tutors were previously
presença de enfisema subcutâneo, hematoma, seroma, infecção consulted about the interest in participating in the present study
local e deiscência de pontos. Não foi necessário converter os and, in cases of agreement, they were informed about the benefits
procedimentos toracoscópicos para cirurgia convencional and possible risks of the procedure.
em nenhum dos caninos. Concluiu-se tratar de uma técnica Fourteen dogs from the routine care of the Veterinary Clinics
segura, rápida sem complicações trans e pós-operatórias. Hospital (Hospital de Clínicas Veterinárias, HCV) of the Veterinary
Ambos dispositivos permitiram aquisição de material suficiente School (Faculdade de Veterinária, FAVET) of UFRGS, of different races,
para análise histopatológica das alterações pulmonares, no ages, body weight and both genders, being nine females and five
entanto a agulha cortante guilhotinada apresentou maior males, were evaluated. The animals included presented radiographic
eficácia, principalmente, em nódulos pulmonares de maior alterations suggestive of pulmonary nodules, with or without clinical
diâmetro. O acesso transdiafragmático mostrou-se eficiente signs. Patients with clinical and laboratory abnormalities that
para exploração de ambos os hemitórax. prevented anesthetic and/or surgical procedures were excluded.
TERMOS DE INDEXAÇÃO: Biópsia pulmonar, toracoscopia All dogs underwent general clinical examination and complementary
transdiafragmática, caninos, videocirurgia, neoplasma pulmonar, preoperative examinations such as abdominal ultrasonography, thoracic
afecções torácicas, cirurgia torácica. X-rays in three projections, electrocardiogram, echocardiography,
hemogram, total platelet count, total plasma proteins, ALT and
creatinine.
INTRODUCTION After previous fasting, the patients received morphine sulfate
Pulmonary parenchymal conditions are common in dogs (0,3mg.kg-1, IM) as preanesthetic medication. A wide trichotomy
and cats. Pneumonias and neoplasias are some of the main of the abdomen and thorax and intravenous administration of
parenchymal diseases. On the other hand, interstitial lung ampicillin sodium (22mg.kg-1) was performed. All animals were
diseases are rarer (Reineiro & Cohn 2007). pre-oxygenated with O2 at 100% for 15 minutes before general
The diagnosis of pulmonary diseases is through anesthesia. Anesthetic induction was performed with propofol
complementary examinations such as thoracic radiography, (4mg.kg-1, IV), followed by the orotracheal intubation. For anesthetic
thoracic ultrasonography, computed tomography, magnetic maintenance, isoflurane was used, vaporized in oxygen at 100%.
resonance imaging, fine needle aspiration, tracheobronchial When necessary, the administration of fentanyl (5mcg.kg-1) in bolus in
(LTB) and bronchioloalveolar lavage (BAL), and bronchoscopy. the transanesthetic period. Local blockade of intercostal innervation
However, definitive diagnosis is often possible only by with lidocaine hydrochloride was performed.

Pesq. Vet. Bras. 38(11):2117-2123, novembro 2018

 Lung biopsy with guillotine cutting needle and biopsy forceps though transdiaphragmatic thoracoscopy in dogs with pulmonary alterations 2119

All patients received multiparametric anesthesia monitoring and the access to the pulmonary surface, handling of instruments and
were placed in supine position, with antisepsis of the thorax and magnitude of the collected fragments were recorded.
abdomen being performed. The site of choice to insert the trocar Samples were kept in a 10% buffered formalin solution and then
was based on the location of the lesion(s) in the thoracic radiograph, submitted for histological analysis. All samples were evaluated by the
usually a caudal intercostal space to the alteration. same pathologist through the Hematoxylin-Eosin staining technique.
A cutaneous incision was made with approximately 0.5cm of Subsequently, the presence or absence of hemorrhage was verified,
extension, longitudinally to the ribs. Subsequently, Halsted hemostatic and trocars were removed, synthesis of wounds made, paraxiphoid
forceps was inserted for intercostal musculature divulsion and pleura and intercostal with Sultan suture pattern, with monofilament nylon
perforation, with consequent induction of pneumothorax, in order 2-0 thread. The skin was sutured with simple isolated stitches with
to reduce the occurrence of iatrogenic lesions to the pulmonary monofilament nylon 3-0 thread. The negative pressure of the thoracic
parenchyma in the moment of insertion of the trocar. cavity was reestablished through thoracocentesis.
A trocar with 5mm of diameter was inserted perpendicularly to The surgery was timed from the first incision to the wound
the thoracic wall progressively. Once the obturator was removed, the closure and any surgical complications or technical difficulties were
insertion of the rigid endoscope with 4mm of diameter and 0° viewing recorded if present.
angle was performed. A rapid exploration of the thoracic cavity The patients received as immediate postoperative medication
was performed, and the endoscope was positioned to visualize the tramadol hydrochloride (4mg.kg-1, IV), dexamethasone (0,25mg.kg-1, IV),
and enrofloxacin (5mg.kg-1, IM). All dogs were discharged after six
diaphragm region for video-assisted insertion of the second trocar,
hours of observation. Patients were submitted to clinical evaluation
by the transdiaphragmatic paraxiphoid access.
at the time of hospital discharge and at 48 hours after the procedure.
A skin incision of approximately 0.5cm was made between the
In this moment, radiographic evaluation of the thorax was also
xiphoid appendix and the costal arch, through which a second trocar
performed. Rectal temperature was measured, possible respiratory
(2nd portal) of 5mm diameter was inserted. After the video-assisted
changes observed, presence of subcutaneous emphysema, hematoma,
perforation of the diaphragm, the endoscope was removed from its
seroma, local infection and dehiscence of stitches, which was not
original position (inside the 1st portal) and repositioned through the
evidenced. The operated area was also palpated to evaluate the
2nd portal. At that time the mediastinal membrane was perforated painful response of the animal.
with the endoscope itself so that it was possible to visualize both Tutors were advised to clean surgical wounds with saline solution
hemithorax. every 12 hours, and to maintain Elizabethan collar until the stitches
After exploring the thoracic cavity and identification, location were removed seven days later. Oral administration of tramadol
and determination of the severity and characteristics of pulmonary hydrochloride (3mg.kg-1, TID, for 3 days), meloxicam (0,1mg.kg-1, SID,
nodulations, the pulmonary sampling instruments were inserted for 4 days), and enrofloxacin (5mg.kg-1, BID, for 7 days) was advised.
sequentially and alternately through the first portal: the biopsy After seven days from the procedure the dogs were evaluated again,
forceps with teeth (1x1), 5mm of diameter and 36cm of length, and the skin stitches were removed.
and the guillotine cutting needle for soft tissue, semiautomatic To verify the viability of the samples obtained with the different
Biomedical of 14 G caliber and with 150mm of length (Fig.1). biopsy instruments, the qualitative analysis of the specimens was
The order of attainment of the samples with each instrument was made. Surgical procedures were evaluated in terms of time to perform
chosen randomly by the team at the time of the procedure. the procedure, frequency distribution of trans and postoperative
Three samples of the same nodule were collected with each biopsy complications, and technical difficulties in performing the procedure,
device. Each sample presented approximately 2mm of diameter if found. The quality of the samples obtained, and the data related to
with the forceps and 1mm of diameter with the guillotine needle. the surgical time, frequency distribution of the technical difficulties
At the time of the harvest, possible technical difficulties related to and possible complications were analyzed descriptively.

Fig.1. (A) Guillotine cutting needle positioned in the thoracic region to obtain a sample. (B) Biopsy forceps positioned inside the thoracic
cavity to obtain a sample.

Pesq. Vet. Bras. 38(11):2117-2123, novembro 2018

2120 Letícia M. Fratini et al.

RESULTS Only one patient presented communication between the

Twenty three dogs with suspicion of pulmonary nodules hemithorax; in the other 13 dogs (92.85%), the mediastinal
were evaluated in the period from April to December 2014, membrane was intact and ruptured with the endoscope
in which 9 were excluded because they presented alterations during thoracoscopy. Intercostal access for the introduction
in the complementary exams, totaling 14 patients included of biopsy devices was also adequate and made it possible to
in this study. grasp the tissue without major difficulties.
In pre-surgical thoracic radiography, three dogs (Dog 5, 7 and 14) Regarding the quality of the material collected by each biopsy
presented effusion in small amount. None presented pre, device, the samples obtained were considered satisfactory,
trans and postoperative complications. No conversion was and it was possible to reach the same diagnosis with both the
required for thoracotomy and all remained alive during the biopsy forceps and the cutting needle in 85.71% of the cases
analyzed period. (Table 1). In two dogs the samples obtained by the biopsy
The mean duration of the procedure was 26.5 minutes forceps were not representative presenting only a focal area
(Fig.2). In four dogs (Dog 3, 5, 6 and 7) the portal had to be of necrosis, and artifact (atelectasis) by compression of the
reinserted into another intercostal space, different from the pulmonary parenchyma.
one planned based on radiography. The option to insert the Little or no bleeding was observed after biopsy. The dogs
second portal through the transdiaphragmatic paraxiphoid did not present hematoma, subcutaneous emphysema,
access guided by endoscopic intercostal visualization was infection and pain during palpation at the surgical site within
safe, without the occurrence of iatrogenic lesion in any of 48 hours until clinical reevaluation. After this period, the
the 14 animals, allowing wide exploration of the thoracic animals were submitted to thoracic radiography, and none
cavity in both hemithorax and excellent visualization of the presented pneumothorax. Dogs 5, 7 and 14 presented a small
pulmonary parenchyma. amount of effusion, which had already been observed in the
radiography prior to the procedure.
Referring to the harvesting technique of the nodules sample,
both devices tested were efficient in seizing and acquiring
the material, obtaining histologically significant samples in
100% of the animals participating in the study.

DISCUSSION
Thoracic effusion found in three of the 14 dogs was probably
due to pulmonary neoplasms (Fossum 2008). Thoracoscopy
was a safe diagnostic tool, easy to perform and without major
complications even in patients with pulmonary involvement,
with a stable clinical picture corroborating with the literature
(McCarthy & McDermaid 1999).
Fig.2. Graphic representation of the surgical time obtained to the The mean duration of the procedure was considered
biopsy guided by thoracoscopy using biopsy forceps and needle short in relation to the conventional thoracotomy biopsy
with guillotine cut, in 14 dogs. Evidencing the learning curve techniques reported in the literature. This is in part due to the
with the reduction of surgical time throughout the experiment. good training and coordination of the surgical team, which

Table 1. Histopathological results of the biopsy with the guillotined cutting needle and the biopsy forceps and location of the
lesions
N Cutting needle sample Biopsy forceps sample Location
1 Papillary adenocarcinoma metastasis Papillary adenocarcinoma metastasis LCrD
2 Tubulopapillary carcinoma metastasis Tubulopapillary carcinoma metastasis LCdD
3 Leiomyosarcoma Atelectasis, areas of necrosis LCdE
4 Chronic pyogranulomatous inflammation Chronic pyogranulomatous inflammation LCdD
5 Adenosquamous carcinoma metastasis Adenosquamous carcinoma metastasis LCdD
6 Cholangiocarcinoma metastasis Cholangiocarcinoma metastasis LCdE
7 Hemangiosarcoma metastasis Hemangiosarcoma metastasis LCdE
8 Osteosarcoma metastasis Osteosarcoma metastasis LCrE
9 Complex carcinoma metastasis Complex carcinoma metastasis LCdE
10 Metastasis of carcinosarcoma Metastasis of carcinosarcoma LCdD
11 Metastasis myoepithelial carcinoma Metastasis myoepithelial carcinoma LCrD
12 Complex carcinoma metastasis Atelectasis, areas of necrosis LMD
13 Mesothelioma Mesothelioma LCdD, med.
14 Pulmonary carcinoma Pulmonary carcinoma LCdE
N = patient number, LCrD = right cranial lobe, LCdD = right caudal lobe, LCrE = left cranial lobe, LCdE = left caudal lobe, LMD = medium right lobe,
med. = mediastinum.

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 Lung biopsy with guillotine cutting needle and biopsy forceps though transdiaphragmatic thoracoscopy in dogs with pulmonary alterations 2121

according to Beck et al. (2004) is essential for performing the choice for the insertion of the first portal was based on the
surgical procedure, although it is important to emphasize that thoracic radiograph, which provided an approximate idea
both the correct positioning of the animals and the adequate of the location of the tumor. The objective of the first access
technical execution of the procedures are indispensable factors portal was to first access the thorax near the area(s) in which
for the execution of the surgery. the tumors were identified by the radiographic images. At the
The learning curve in video-surgery makes operative time same time, the intercostal access was used to perform the
decrease as the surgeon gains experience with the technique previous exploration of the corresponding hemithorax and to
and becomes more familiar and adapted to the instruments facilitate the insertion of the transdiaphragmatic paraxiphoid
and equipment (Faraco 2013). This can be observed in this portal under endoscopic visualization.
study in which surgical time was reduced throughout the The option to insert the second portal through transdiaphragmatic
experiment. This finding corroborates with Santos & Bravo paraxiphoid access guided by endoscopic intercostal visualization
Neto (2010), who affirmed that the success of a procedure was safe, without the occurrence of iatrogenic lesion in any of the
requires, besides an accurate indication, technical ability, which 14 dogs of this study, corroborating the reports of Pigatto et al.
is based on the repetition of movements and goes through a (2008) and Basso et al. (2010). However, it is noteworthy that in
phase in which the learner acquires competence quickly, to these studies the pneumothorax was instituted by insufflation
then reach a plateau, after which no difference is observed in of the thoracic cavity with CO2 which facilitated diaphragm
the gain of the abilities, although it continues to gain speed. distension and the transdiaphragmatic paraxiphoid trocar
According to Beck et al. (2004), previous surgical planning, insertion safe.
including the positioning of the tower, the surgical team In four dogs (Dog 3, 5, 6 and 7) the portal had to be
and anesthetic is fundamental for the good progress of the reinserted into another intercostal space, different from the
procedures in the video-surgery. In the present experiment, one planned based on radiography. It is believed that this
this planning was established before all the procedures, so that mistake occurred due to image overlap in the radiographic
the surgical team was able to carry out the surgical maneuvers examination. According to Norris  et  al. (2002), thoracic
in a comfortable and safe way. Regarding the positioning of the radiography is a good screening test, but because it does not
patients in the supine position, it was verified that this allowed detect lumps smaller than four millimeters and often present
the introduction of the trocars both through intercostal access overlapping images it is a limited examination. Thus, the
and transdiaphragmatic paraxiphoid without major difficulties, anesthetic block of two caudal and two cranial intercostal
besides allowing visualization of the mediastinum of the thoracic spaces was indispensable to the planned access site, in order
wall, pulmonary lobes except the dorsal face, pericardium, to obtain a wider access margin.
lymph nodes, large vessels, esophagus and diaphragm. Another fact that strengthens the radiographic examination,
In all dogs included in the project, two trocars (portals) in relation to the identification of small pulmonary nodules
were used to access the thoracic cavity. The first portal was and, at the same time, presents a quality of presentation of
inserted in the intercostal region, and the second through the surgical procedures, is related to the fact that in seven
transdiaphragmatic paraxiphoid access (Fig.3). The site of dogs (50%) the number of lesions were lower than those
seen during thoracoscopy. Schmiedt (2009) and Radlinsky
(2014) highlight the diagnostic character of the thoracoscopic
procedures as one of the advantages that this access allows.
It should be noted that, according to the findings of the present
study, thoracic radiography characterizes an important stage
as a screening test in patients with suspicion of thoracic
malignancies. However, for greater sensitivity and specificity,
the thoracoscopic approach is recommended.
In this study, since dogs presented respiratory compromise,
undo the negative thoracic pressure, without the additional
insufflation of CO2, was the chosen option. For this, the initial
approach to the thorax was performed through intercostal
access. This provided greater safety, reducing the risks of
iatrogenesis to the intrathoracic structures that could be
caused by transdiaphragmatic paraxiphoid access, without
the recommended previous pneumothorax.
The option for the initial intercostal approach, besides the
safety provided in the endoscopic view of the insertion of the
transdiaphragmatic trocar (2nd portal), also allowed to observe
the entire diaphragm region, which cannot be performed
through the cavitary visualization by the transdiaphragmatic
paraxiphoid access. This maneuver was important because
some dogs also had nodules on the diaphragmatic wall. The use
of two 5mm diameter access portals, the first intercostal and
the second transdiaphragmatic paraxiphoid, proved to be a
Fig.3. Schematic representation of the equipment, surgical team good option, regarding also to the extent of thoracic cavity
and positioning of the portals in the patient. exploration. The possibility of a change in the position of the

Pesq. Vet. Bras. 38(11):2117-2123, novembro 2018

2122 Letícia M. Fratini et al.

4mm optic, alternating its insertion through the intercostal and this occurred by second intention, probably by the deposition
paraxiphoid portal during the procedures allowed a greater of fibrin buffer in the sectioned site, dispensing sutures in
reach both in the visual exploration as in the performance of the pulmonary parenchyma. This can be evidenced by the
the punctures and the pulmonary parenchyma. absence of pneumothorax in the radiographic evaluation of the
The formation of pneumothorax is essential to prevent dogs 48 hours after the procedure. According to Lamounier
lesions of the pulmonary parenchyma at the time of the (2006) there is a minimum air escape after the removal of
insertion of the trocar and to obtain full visualization of the pulmonary fragments of up to 0.5cm in diameter, because
intrathoracic structures (Walsh et al. 1999, Peroni et al. 2001). the clamp used promotes tissue crushing.
In this study, the divulsion of the intercostal muscles and The use of guillotine cutting needle to obtain pulmonary
thoracic cavity were performed with Halstead hemostatic biopsy in dogs has not been described in the literature yet.
forceps, thus reducing the negative pressure of the thorax. In humans it is a technique already consolidated and of
This maneuver provided insertion of trocars with little resistance, everyday use in the routine. In this study, the acquisition
adequate pneumothorax and avoided possible iatrogenic of histologically significant samples occurred in 100% of
lesions on the lung. These results corroborate with the study the dogs participating in the study was observed. Even in
of Isakow et al. (2000) that produced pneumothorax only with lesions of reduced diameter it was possible to obtain material,
musculature divulsion and perforation of the parietal pleura. corroborating with Chojniak et al. (2011), whom concluded
Landreneau  et  al. (1994) reported that intrathoracic that percutaneous cutting needle biopsy has become one of the
inflation with carbon dioxide in thoracoscopic procedures main choices for nodule and mass investigation. Its versatility
is not essential and only assists the inspection of the pleural allows the access of lesions in different locations of the lung,
cavity by the total lung collapse that it produces and, in addition being able to be used for peripheral and deep lesions even
to the small distension of the cavity it promotes, enlarges the of small dimensions, achieving 97% success in obtaining
visual field of the thorax. But they can cause increased blood viable samples.
pressure and compromise circulatory dynamics. After the end of the procedure, thoracentesis was chosen
The choice for transdiaphragmatic paraxiphoid access for to restore the negative pressure in the thorax. The crushing
the insertion of the endoscope allowed extensive exploration caused by the forceps, the reduced diameter of the samples
of the thoracic cavity in both hemithorax and excellent collected and alteration present in the pulmonary parenchyma
visualization of the pulmonary parenchyma, corroborating avoided the formation of pneumothorax, making the use of
with the studies of Twedt (2002), Pigatto et al. (2008) and the thoracic drain unnecessary. Fossum (2008) reports that
Basso et al. (2010). It is known that both dogs and cats may despite a low incidence, formation of pyogranulomas, pleuritis
present communication between the hemithorax physiologically and adhesions between lung and thoracic wall may occur
(Orton 1998). when thoracic drainage is used.
Regarding the quality of the collected material, in general,
satisfactory indexes of success in obtaining appropriate CONCLUSIONS
material for analyzes above 85% are considered satisfactory We can conclude that both biopsy collection devices tested
(Chojniak et al. 2011). demonstrated efficacy, but the semiautomatic guillotine cutting
It is believed that in the two patients in which the samples needle provided a better diagnostic result when compared
collected were not significant, it is due to the fact that many to the biopsy forceps, especially in the collection of larger
tumors, regardless of their histological origin, present an area tumor nodules.
of peritumoral cell necrosis. Thus, larger diameter nodules Transdiaphragmatic paraxiphoid thoracoscopy was adequate
tend to present their outermost layer composed only of for the bilateral assessment of the chest cavity and obtaining
cellular debris and necrosis (Jones et al. 2000). pulmonary biopsy in dogs from any lobe of both lungs and
The guillotined needle sample was more representative presented as a fast and safe technique even in animals with
in the larger diameter neoplastic lung lesions. It is possible to pulmonary involvement, with a stable clinical picture.
observe in these the shape and the arrangement of the tumor
cells, since the needle reached all the layers of the lesion. REFERENCES
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Basso P.C., Raiser A.G., Brun M.V., Guizzo Junior N., Feranti J.P.S., Motta A.C.,
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