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Three consecutive male patients underwent videoscopic supradiaphragmatic thoracic duct division using the Harmonic Scalpel with a hook blade (Ethicon Endo-Surgery, Cincinnati, OH, USA) for treatment of chyle leaks that developed after left upper lobectomy, graft replacement of a descending aortic aneurysm and thyroidectomy with concomitant partial sternal resection. The thoracic duct was exposed and divided using just the Harmonic Scalpel. The operations lasted 40, 20 and 18 min. No mortality, morbidity or recurrence occurred during follow-up periods of 27, 17 and 9 months. The Harmonic Scalpel with a hook blade can facilitate supradiaphragmatic exposure of the thoracic duct.

Videoscopic supradiaphragmatic thoracic duct division using ultrasonic coagulator