Perikardiektomia torakoskopowa. Wskazania i techniki u małych zwierząt. Część II/Thoracoscopic pericardectomy. Indications and techniques in small animals. Part II

Do we need a specific instrumentation?

Angled scopes are a bit more difficult to get acquainted to but enable the surgeon to look behind organs without the need to displace them. With a 30° scope, the field of view can be enlarged by simply turning the scope within the camera head. Therefore we prefer 5 mm 30° scope for thoracoscopic surgery. In cats and small dogs, 2.7 mm scopes have also been used.

Additionnal instruments will be needed beside the usual endo-grasper, endo-scissors and endo-probes:

A suction/irrigation device is necessary to aspirate and rinse the pericardial fluid.Endoscopic stapling is mandatory for tumor removal. The most common stapler used is the EndoGIA (Covidien) places two triple rows of staggered staples that are separated by a cutting blade, thus allowing secure sealing on each side of the cut and preventing back bleeding into the surgical field.Specimen retrieval bags should be used when tissue that could be neoplastic is to be removed through a small port incision.

Because of lack of direct access, bleeding should be avoided by any mean and hemostasis should be performed readily. Bleeding will occur preferentially from the ventral mediastinum (39) after it has been severed or from the inflamed pericardium when the latter is being cut. Monopolar and bipolar capabilities are mandatory for pericardectomy. Most of the endoscopic instruments can be connected to electro-coagulation generators enabling coagulation while dissecting or cutting.

However, new energy-delivery devices such as harmonic scalpel, Remorgida bipolar electrocautery, and bipolar vessel-sealer devices (Ligasure, Enseal) allow coagulation or sealing and section, in a safer and quicker manner as regular instruments and electro-coagulation units and are recommended (See Video 1).

Pericardectomy and thoracic duct closure

Pericardectomy associated with thoracic duct ligation has been advocated both in dogs (23, 42) and cats (25). These procedures have...

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