Pericardectomy

Creation of a window in the pericardium establishes permanent drainage for patients with pericardial effusion. This procedure is performed effectively using minimally invasive technique with greatly reduced operative trauma and postoperative pain. Subtotal pericardectomy is also possible with thoracoscopy but it is rarely performed.

Pericardial window

Approach

To perform a pericardial window the patient can be placed in dorsal recumbency or in lateral recumbency.

If the patient is in dorsal recumbency, a para-xiphoid transdiaphragmatic approach with the telescope portal in the para-xyphoid position is performed. The two instrument portals are placed in the right side and in the left side. The portals are in the left and right 9^th to 10^th intercostal spaces. Place all portals ventral to the costochondral junction in the area of the lateral margin of the transverse thoracic muscles to allow better freedom in the motion of the instruments. If the instrument portals are too far dorsal then the instruments cannot cross from one hemithorax to the other.

If the patient is placed in left lateral recumbency, the camera portal is placed in the ventral third of the 6th or 7th intercostal space. Then the two instrument portals are introduced in the 4th intercostal and the 8th intercostal spaces. This approach allows a better visualization of the right atrial appendage and aortic root and is recommended for visualization of heart base tumors. Using this approach, a right-sided pericardial window is created. It is paramount with this approach to identify the phrenic nerve prior to incising the pericardium. [...]