255 Is It Possible to Reduce Thoracic Duct Injuries in Brachial Plexus Surgeries? Anatomical Study on Fresh Cadavers

INTRODUCTION: Brachial Plexus (BP) surgery are complex due to the difficulty to recognize the anatomical structures. One of the complications reported in 1 to 5% of surgeries is injury to the Thoracic Duct (TD), which results in chylothorax, prolonging the length of hospital stay. One of the main reasons for the occurrence of injuries is surgeons' lack of knowledge about the anatomical relationship. between DT and BP. To date, there are no studies in the literature that study the anatomical relationship between these two structures. METHODS: Anatomical study on fresh cadavers, with a level of precision calculated at 3mm, sample size calculated at 72 specimens, statistical significance 0.05, 95% confidence interval. Dissection on left side, using a previously trained and validated standardized technique, we studied the place of DT termination and relationship with PB structures. RESULTS: The DT was found on the left in 100% of the specimens, on average 3.5 cm above the clavicle, most often ending in the Internal Jugular Vein, parallel to the PB, the structures closest to the DT were the Phrenic Nerve and the C5 root at an average distance of 17mm. CONCLUSIONS: This work presents a large series of dissections in fresh specimens, and its findings allow increasing the safety of PB surgeries, thus reducing the chance of TD injuries, for this we recommend that the If surgical exploration is performed on the left, especially when using the phrenic nerve, dissection and isolation of the DT must be carried out before dissection of neural structures. There is a great proximity between the TD and PB at a distance of less than 2 cm, most of the time being parallel structures.