Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection.

Objective: To describe the feasibility, efficiency, and extent of thoracoscopic pericardiectomy (TP) on a ventilated dog with an intercostal approach in lateral recumbency (ILR), in comparison with the traditional transdiaphragmatic paraxiphoid approach in dorsal recumbency (PDR).

Study design: Randomized experimental study.

Animals: Twenty canine cadavers (n = 10 per group).

Methods: Thoracoscopic pericardiectomy was performed on mechanically ventilated cadavers to remove the largest pericardial fragment possible using either the ILR or PDR technique. Approach and procedure time were recorded, and surgical extent (cardiac exposure/exteriorization, pericardial fragment area) was assessed. Procedural difficulty and intraoperative visibility were also assessed to evaluate feasibility.

Results: Total surgical time (sum of approach and pericardiectomy time) did not differ between groups, although PDR pericardiectomy took longer (p = .045) by an average of 5.2 min. Exteriorization of the heart from the pericardial sac was achieved for all trials. Pericardial fragments from PDR trials were larger than those of ILR (p = .004), with a mean difference of 23.21 cm². Cardiac exposure and operative visibility scores were greater for PDR procedures.

Conclusion: The ILR approach with bilateral ventilation was a feasible alternative for performing partial pericardiectomies, which did not require more total surgical time when compared with the PDR approach.

Clinical significance: The ILR approach for TP warrants further evaluation in live dogs as it may hold promise for treating causes of pericardial effusion that do not require subtotal pericardiectomy and improving efficiency when paired with other ILR procedures such as thoracic duct ligation.